Executive summary
The cyclone that struck Myanmar on 2 May 2008 quickly became the country's most devastating disaster. Cyclonic winds, heavy rainfall and in some coastal areas, a 4 metre tidal surge, left a death toll of 84,537 victims, with 53,836 people regarded as missing and 19,359 injured. Overall, cyclone Nargis severely affected some 2.4 million people (of an estimated 7.35 million people living in the affected townships). Of them, an estimated 200,000 were 55 years or older at the time of the disaster.
In addition to the human toll, the cyclone ruined most of the fertile fields, contaminated most of the water supply and destroyed hundreds of thousands of unstable houses and other vital infrastructure such as health facilities.
Emergency response
The immediate action of individuals, village leaders, community organisations and monasteries was followed by relief from the government and where (and when) possible, a number of national and international nongovernment organisations. The scale of the destruction and the difficult access to some areas left some people still unreached by the end of May.
HelpAge International, a network of organisations concerned with improving the lives of older persons, was the only responding agency that included a specific focus on the needs of older people. HelpAge's relief programme targeted two townships (Kyaik Lat and Dedeye) with four components: 1) food distribution, 2) provision of non-food items, 3) mobile medical units and 4) shelter repair and reconstruction. Although food was distributed to any household and anyone could access the HelpAge medical service, the non-food items and shelter relief were targeted towards households with occupants aged 55 years or older.
At the time of this nine-month assessment, many relief programmes (including from HelpAge) were being phased out or had ended already. Distribution of food and non-food items had ceased in most areas by the end of December 2008; in a few of the worst affected areas, government and non-government mobile health services remained in operation.
The nine-month assessment
HelpAge conducted an assessment of the situation of older people 100 days after the Nargis cyclone created its destruction across Myanmar's delta region. Nine months later, HelpAge returned for a second assessment on the situation of older people in three townships (two where HelpAge had worked and one where it did not) and to determine how older people had been included in the emergency response and with what outcomes.
Research methodology
A total of 326 older respondents (106 in Kyaik Lat, 109 in Dedeye and 111 in Bogale townships) were questioned through a standardised survey about their socio-economic situation, nutrition and food security, shelter, health and psychological well-being and their perceptions of the emergency response. More in-depth interviews on livelihood were conducted with a total of 18 older persons (six in each township). Six focus group discussions centred on the psychological impact of the cyclone and the inclusion of older people in the emergency response. All the participants were 55 years or older; the largest proportion of respondents were 70 years or older. All of the respondents in two of the townships had received some HelpAge assistance. The third township, where HelpAge did not conduct any relief programme, was included for comparative purposes.
Both qualitative and quantitative methods were applied in the nine-month assessment, which was carried out in the three townships: Kyaik Lat, Dedeye and Bogale. Ten villages in Kyaik Lat and ten in Dedeye where HelpAge implemented its emergency programmes were selected as the 'project' group. Another ten villages in Bogale, where HelpAge had not directed any relief work, were chosen as the 'control' group. Bogale differed from the other two areas in that older people were not specifically targeted for service delivery, despite the comparable emergency situation.
The assessment was designed to look for observable differences in the situation of older people nine months after the Nargis disaster and how older people were included in relief programmes in different settings.
Main findings
Community cohesion, underpinned by a traditional support system, was evident in the immediate aftermath of the cyclone. Local communities and individuals, despite their condition, led the initial relief response and made efforts to prioritise and protect vulnerable groups, including older people.
The longer-term livelihood security of older people had not been sufficiently restored nine months after the Nargis disaster. About half of the respondents whose cultivated land was destroyed had regained it, and only one-third of those whose poultry had been swept away had replaced them. Severely diminished opportunities for wage labour posed a further threat to livelihood security. While 61 per cent of older people in the assessment study reported doing occasional work for cash before the Nargis disaster, only 42 per cent reported that they still did so.
Despite the loss of productive assets, income-earning opportunities and evident contributions of older people to household livelihoods, none of the study participants reported being a beneficiary of any livelihood-support programme. This was a critical gap in the relief assistance identified by older people in all research sites, who viewed this as important for their future livelihood security.
For many of the older respondents, weakened livelihoods and reduced earning opportunities also threatened their food security. Half of their monthly household income was spent on food; many people expressed concern about their ability to manage since the food relief had stopped.
Older people reported eating smaller amounts and less often since the cyclone. Overall, an average of 37 per cent of the respondents reported having enough to eat most of the time, while 11 per cent said they were often hungry.
A large proportion of respondents reported their house had been totally destroyed; this was especially the case in Bogale where cyclone damage was most severe. However, 71 per cent of the respondents in Kyaik Lat and 59 per cent in Dedeye reported their home had been totally repaired. In Bogale where HelpAge did not direct any relief operation, the situation was less positive, with only 25 per cent of respondents reporting a repaired home.
The targeting of shelter repairs in project areas had an obvious and significant impact on older people. Those who received repairs spoke of regaining a sense of security and independence and an easing of the burden they felt they placed on others because of their dependency.
Mobile health services were also highly valued by older people because they were accessible, regular and free of charge. Many survey respondents and other assessment participants expressed concern about the loss of these services, fearing they could no longer afford the same level of healthcare in future.
Older people strongly related their psychological well-being to material support they received during the emergency. A greater sense of well-being was found among those who lived in HelpAge project areas, whose material situation appeared better off compared with the control area.
The older respondents reported two persistent anxieties: their future well-being and another cyclone. Comparing their life nine months after the disaster to what it had been before the cyclone struck, only 21 per cent acknowledged it was 'back to normal'. Some 14 per cent of the respondents noted that life was still 'more difficult than before Nargis'.
Lessons and policy recommendations
Strong community cohesion was evident during the initial stages of the emergency. Relief assistance programmes that reinforce and build on this capacity, for example, the ability to identify the most vulnerable people, would strengthen community ownership of relief efforts and their involvement in planning longer-term recovery processes.
Older people need many services, such as healthcare and livelihood support. These needs have either not been addressed or are under threat as the relief phase ends. Health services that are accessible, regular, reliable and free of charge proved essential for older people. Efforts to support the development of such permanent services with specialist knowledge of common health conditions of older people would benefit older people and those who care for them. Measures to ensure the longer-term recovery of older people and their households would also include inputs or loans to support livelihoods of older people.
Interventions targeted to older people had positive benefits to their households. Appropriate integration of older people in all recovery programmes, including livelihood support, would enable more older people to maintain their contributions and independence and, as a consequence, strengthen the community capacity to support older people - even in the event of another cyclone. Programmes should ensure the participation of older people in planning and implementation (as HelpAge did in its shelter programme) to ensure their needs are addressed and that communities are aware of their needs and how they can include older people appropriately.
Older people are among the most vulnerable in times of food shortage. Although food aid reached all households, it may be important to recognise the longer-term food security needs of vulnerable groups such as older people.
In the emergency phase, material support was the most significant factor contributing to older people's psychological well-being. Spiritual health, other psycho-social support activities and home-visiting programmes could be considered in the post-emergency recovery phase.
There is need for greater coordination among humanitarian agencies to develop programmes that are inclusive and meet the essential needs of vulnerable people, including older people, as highlighted in this assessment.
Government and other agency assessments and data collection need to include information on older people in order to develop appropriate responses in the relief and recovery phases.
Disaster preparedness remains weak. Many older people expressed fear of another cyclone. These fears could be justified in light of the apparent fragility of basic infrastructure. Village water storage tanks, a strong food store and strong community building might be priorities.
Existing community support systems were found to work well in terms of including older people. These systems may be weakened in the future if economic out-migration from rural areas follows the trend of other Asian countries. It will thus be vital to ensure that disaster risk reduction programmes, including a strong component of preparedness, are developed and based on the experiences in the Nargis-affected areas of Myanmar. In addition, using the momentum created, it would be wise to discuss with the Government of Myanmar the expansion of a disaster risk reduction programme in regions other than those affected by cyclone Nargis.